=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184951121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEX JONES DENTAL PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2009
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12419 CANTRELL RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-223-8442
-----------------------------------------------------
Fax | 501-224-2900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12419 CANTRELL RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-223-8442
-----------------------------------------------------
Fax | 501-224-2900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL COORDINATOR
-----------------------------------------------------
Name | MISTI YORK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-223-8442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 3562
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------